2021-11-10T16:45:00-06:00 2020-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2020-01-01 941044474 Lodi Memorial Hospital Association Inc LODI 9164060000 975 S Fairmont Avenue Lodi CA 952405118 Jason Whitney Treasurer 9164060000 2021-10-21 1 Jason Whitney 999009999 Tracy S Paglia P00366884 2099556100 2021-10-21 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Adventist Health Lodi Memorial John Bearman 975 S Fairmont Avenue Lodi CA 952405118 254554944 0 1071 X www.adventisthealth.org/lodi-memorial/ X 1945 CA Living God's love by inspiring health, wholeness and hope. 14 12 1411 13 146599 0 2735423 3269319 241327051 249590640 1960474 1678832 83563 -28800 246106511 254509991 100085 201593 0 0 102001240 95682754 0 0 442598 143924606 156262298 246025931 252146645 80580 2363346 239446881 263442209 166271894 189399077 73174987 74043132 X Living God's love by inspiring health, wholeness and hope. 0 0 199695444 201593 249590640 See Schedule O 199695444 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 0 0 1411 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CA X Todd Hofheins CFO 9164060000 PO Box 619135 Roseville CA 95661 X Larsen David - Former Finance Officer, CCR thru 04/19 0.00 50.00 X 0 3202560 614651 Reiner Scott Dir/Chair 0.00 50.00 X X 0 2358378 54819 Wing Bill Dir/Asst Secr/Vice Chair 0.00 50.00 X X 0 1760327 59054 Jahn Andrew President, Care Division 2.00 48.00 X 0 1365841 59307 Ferch Wayne President, CCR 8.33 41.67 X 0 1298607 49186 Nahapetian Arby - Care Division Chief Medical Officer 2.00 48.00 X 0 868206 54711 Reppert Joseph Former CFO/Asst Secr thru 08/19 0.00 0.00 X 0 813425 41111 Jobe Meredith Secretary 0.00 50.00 X 0 769985 43868 Chen Steven Finance Officer, CCR 8.33 41.67 X 0 719712 59174 Wolcott Daniel President thru 12/20 50.00 0.00 X 0 695987 59307 Gruzensky Denton Reg HP Dir, CCR 8.33 41.67 X 0 607539 36465 Iris Patricia Medical Officer 8.33 41.67 X 0 492077 44664 Hofheins Todd CFO as of 08/20 0.00 50.00 X 0 469107 13281 Whitney Jason Treasurer 50.00 0.00 X 0 360067 59032 McCollough Brooke Operations Executive 0.00 50.00 X 0 340523 62515 Grimm Mary Patient Care Executive 0.00 50.00 X 0 332549 42885 Cook Becky - Ambulatory & Physician Services Exec 8.33 41.67 X 0 279774 39378 Moreno Debbe Former CNO thru 09/19 0.00 50.00 X 0 278436 30401 Markovich Jennifer Director, RN 50.00 0.00 X 232925 0 55409 Wagner Jack Former Asst Secr thru 03/18 0.00 0.00 X 0 269387 13558 Beck Atwater Sandra Director Hospital Pharmacy 50.00 0.00 X 229028 0 46100 Carmody Thomas Physician Assistant 50.00 0.00 X 235405 0 36105 Karagounis Timothy Operations Executive 50.00 0.00 X 228830 0 32964 Pascua Helen RN, First Assistant 50.00 0.00 X 238472 0 17484 Pickering Christine Communication Dir, CCR 8.33 41.67 X 0 182763 63138 Spenst Brett Interim President as of 12/20 50.00 0.00 X 0 113171 7910 Freedman John Director 0.00 4.00 X 0 27216 0 Davis Andrew Director 0.00 4.00 X 0 26971 0 Reiner Richard Director 0.00 4.00 X 0 26764 0 Cherry Robert Director 0.00 4.00 X 0 26160 0 Innocent Larry Director 0.00 4.00 X 0 25608 0 Graham Ricardo Director 0.00 4.00 X 0 23359 0 Heinrich Kerry Director 0.00 4.00 X 0 20608 0 Woodson Marc Director 0.00 4.00 X 0 20608 0 Ocampo Lucy Director 0.00 4.00 X 0 20358 0 Banks David Director 0.00 4.00 X 0 15441 0 Salazar Velino Director 0.00 4.00 X 0 6651 0 Fehr Joy Director 0.00 4.00 X 0 108 0 Philip Celeste Director thru 04/20 0.00 4.00 X 0 0 0 1164660 17818273 1696477 330 1 1 0 Regents of the University of California 1111 Franklin Street 12th floor Oakland CA 94607 Physician Professional Fees 8585805 CEP America - Anesthesia PC 2100 Powell Street Suite 900 Emeryville CA 94608 Physician Professional Fees 3057394 GE Precision Healthcare LLC PO Box 96483 Chicago IL 60693 Construction 2900772 Elekta Inc PO Box 404199 Atlanta GA 30384 Construction 2287439 NELCO Worldwide 2 Burlington Woods Drive Suite 300 Burlington MA 01803 Construction 2274567 34 2449204 820115 543000 3269319 Patient service revenue 621400 226144500 226144500 CARES Act Revenue 621990 16482998 16482998 340B Pharmacy Revenue 621400 2210402 2063803 146599 Related rental revenue 621400 398256 398256 Premium revenue 621990 300476 300476 4054008 4054008 249590640 1678832 1678832 12713 40090 -27377 -27377 -27377 3440 4863 -1423 -1423 254509991 249444041 146599 1650032 X 201593 201593 373615 373615 75734763 69520015 5871306 343442 3460408 3278900 164872 16636 10605826 10165803 395401 44622 5508142 5131648 353469 23025 22287690 336724 21950966 164550 164550 30611 30611 15292 15292 50223192 38887304 11327231 8657 15440 15440 1264327 579294 679856 5177 9124833 2618267 6506566 4981649 4217014 764635 118348 72178 46170 77980 26865 51115 4012574 4012574 9028419 8981519 46900 743069 742069 1000 Patient care supplies 30635434 28328732 2305663 1039 Hospital Medi-Cal Quali 13031592 13031592 Leased equipment expens 591610 589830 1780 UBI taxes 3000 3000 9912688 8581616 1331072 252146645 199695444 52008603 442598 38010058 54712239 20750 12258 31272151 34556137 3299452 4136078 1008686 964708 275807388 152379195 121880530 123428193 8977126 7481924 34978128 38150672 239446881 263442209 20120044 22091369 0 19085 0 426046 146151850 166862577 166271894 189399077 X 70003285 70812858 3171702 3230274 73174987 74043132 239446881 263442209 X 2363346 -1495201 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 15292 15292 0 Part II-B, Line 1: The Hospital belongs to industry and professional associations for which a portion of the membership dues is used for lobbying activities. Expenditures to Noteware were paid for the purpose of working with legislators and government officials relating to legislation affecting hospitals and healthcare. 3171700 2663248 2604674 3230274 541320 2659952 29572 3171700 602023 569686 630389 541320 562343 689003 3000 41917 602023 547340 148830 133827 562343 0.00000 0.00000 1.00000 0 0 9973938 9973938 191643204 97730291 93912913 3227133 3024125 203008 58769971 48182730 10587241 12193142 3442049 8751093 123428193 Receivables from third-party payors 26964939 Receivables from related organizations 10943050 State Board of Pharmacy receivable 116726 Other assets 125957 38150672 Payable to related organizations 139950168 Other liabilities 14147934 Payables to third party payors 12764475 166862577 X Part V, Line 4: Board-designated, temporary and permanently restricted endowment funds are for specified operating and capital projects. The funds are released as project costs are expended. Part X, Line 2: The principal operations of the System are exempt from taxation pursuant to Internal Revenue Code Section 501(c)(3) and related state provisions. The System recognizes tax benefits from any uncertain tax positions only if it is more-likely-than-not the tax position will be sustained, based solely on its technical merits, with the taxing authority having full knowledge of all relevant information. The System records a liability for unrecognized tax benefits from uncertain tax positions as discrete tax adjustments in the first interim period the more-likely-than-not threshold is not met. The System recognizes deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of its assets and liabilities, along with net operating loss and tax credit carryovers only for tax positions that meet the more-likely-than-not recognition criteria. At December 31, 2020 and 2019, no such assets or liabilities were recorded. The System currently files Form 990 (informational return of organizations exempt from income taxes) and Form 990-T (business income tax return for an exempt organization) in the U.S. federal jurisdiction and the state of California. The System is not subject to income tax examinations prior to 2016 in major tax jurisdictions. 1 1 X 1 X 1 X 1 1 1 0 1 1 493894 493894 0.00200 77574749 63265321 14309428 0.05680 78068643 63265321 14803322 0.05880 616647 777 615870 0.00240 708740 708740 0.00280 14861685 41401 14820284 0.05880 14291 14291 0.00010 16201363 42178 16159185 0.06410 94270006 63307499 30962507 0.12290 50366 50366 0.00020 3038 3038 0.00000 8533 8533 0.00000 61937 61937 0.00020 1 2003834 208876 52905894 57339646 -4433752 X 1 1 2 Lodi Outpatient Surgery Center Ambulatory Surgery Center 0.78000 0.00000 0.22000 2 1 Lodi Memorial Hospital Association Inc dba AHLM 975 S Fairmont Ave Lodi CA 95240 www.adventisthealth.org/lodi-memorial/ 030000056 X X X A 2 Lodi Memorial Hospital - West dba AHLM 800 Lower Sacramento Road Acute Phys Lodi CA 95242 www.adventisthealth.org/lodi-memorial/ 030000056 X X Outpatient departments at this campus A Facility Reporting Group - A 0 0 1 X X X X X X X X X 19 1 1 1 1 X See Sch H Part VI - Needs Assessment X See Sch H Part VI - Needs Assessment X 1 19 1 See Sch H Part VI - Needs Assessment 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X Sch H Part VI-Patient Educ X X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Lodi Memorial Hospital Association, Inc. dba A, - Facility 2: Lodi Memorial Hospital - West dba AHLM Facility Reporting Group - A Part V, Section B, line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts; 2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Community input was provided by a broad range of community members using key informant interviews, focus groups, and surveys. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from local governmental and public health agencies as well as leaders, representatives, or members of underserved, low-income, and minority populations. Additionally, where applicable, other individuals with expertise of local health needs were consulted. Thirteen key informant interviews individuals representing diverse sectors in San Joaquin County including: public health, health care, community-based organizations, social services, education and government. Thirty-one community resident focus groups were conducted in geographic areas within San Joaquin County, including Stockton, Lodi, Tracy and Manteca. Nineteen groups were conducted in English, ten were conducted in Spanish, one was conducted in Tagalog and one was conducted in Cambodian. Participants were teens, adults, and older adults, who represented underserved, low-income, and varied ethnic communities.Secondary data sources include collected data on key health indicators, morbidity, mortality, and various social determinants of health from the Kaiser Permanente CHNA Data Platform, Health Places Index, American Community Survey and various other state and federal databases. Facility Reporting Group - A Part V, Section B, line 6a: Hospitals that participated in the 2019 CHNA process included Dameron Hospital, Kaiser Permanente, Sutter Health and Dignity Health St. Joseph's Medical Center. Facility Reporting Group - A Part V, Section B, line 6b: Other non-hospital facilities that participated in the 2019 CHNA process included Community Medical Centers, First 5 San Joaquin, Health Net, Health Plan of San Joaquin, San Joaquin County Public Health Services. Facility Reporting Group - A Part V, Section B, line 11: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Our 2019 CHNA identified three areas of significant need: Mental Health, Economic Security, and Obesity/Healthy Eating Active Living (HEAL)/Diabetes. Priority Need 1 - Mental Health - The goal is to improve trauma informed care by creating awareness of trauma and providing or connecting our patients with the proper resources to address trauma. Strategy 1.1 - Hire a substance use navigator in our emergency department. Activity 1.1 - Substance Use Navigator (SUN). AHLM applied for funds under the Behavioral Health Pilot Program (BHPP) to support a substance use navigator (SUN) in our emergency department (ED). This initiative is an important step toward reducing the severity of behavioral health issues impacting AHLM's service area, with a focus on substance use disorders (SUD) and specifically opioid use disorders (OUD). Specific outcomes to be achieved under this pilot project will include decreasing deaths from opioid-related overdoses, combat stigma surrounding opioid and other substance use disorders, and to improve the quality of care provided to patients with SUD/OUD. Other work around mental health included webinars through AHLM's collaboration with the American Heart Association and the Lodi Chamber of Commerce. These webinars included the following topics, "Supporting Mental Resilience for Good Heart Health During COVID-19 and "Transitioning Back to Work Amid COVID-19". Finally, in 2020 AHLM signed on to become a funding partner of the Unite Us platform to participate in the San Joaquin County's Connected Community Network (CCN). Priority Need 2 - Economic Security - The goal is to improve economic security in our county by improving career opportunities for our residents, increasing the supply of qualified workers to meet the needs of the healthcare industry, and improve the overall health of our local businesses. Strategy 1.1 - AHLM has partnered with Health Force Partners to improve career pathway opportunities for community residents and to increase the supply of skilled workers to meet the needs of dynamic healthcare industry in the Northern San Joaquin Valley. Strategy 1.2 - AHLM is also collaborating with the American Heart Association and the Lodi Chamber of Commerce's Health Value Action Team to provide our local businesses with a nationally successful program, the Workplace Health Solutions. The program will offer local businesses a suite of science-based, evidence-informed tools and services to help build a workplace culture of health. Activity 1.1 - Participation in the HOPE pilot program. AHLM launched its first cohort of the HOPE (Helping Our People Elevate) pilot program in January 2020. The HOPE program includes two parts. Part one includes Adventist Health taking incumbent workers who have met all requirements for the Delta's RN program and placed them into an 18-month accelerated AND program. The hospital provides the clinical instructor as well as an optional cost of living stipend for participants. The number of participants enrolled in the HOPE program included 11 students who are set to complete the program in May 2021. This program is open to the public and therefore meets the requirements to count towards community benefit efforts. Activity 1.2 - Health Careers Academy - The second part to the HOPE program is working with the Health Careers Academy to have a pilot fast track program for high school students. The students begin taking classes that count toward their AA degree and RN program prerequisite courses in their junior year of high school, and then continue classes through the summer. When they graduate their senior year of high school, they are nearly done (or are done) with their RN prerequisite and can enter the ADN program. The hospital provides the clinical instructor and employment as a student extern. The student commits to work at the hospital for a certain amount of time after that. Due to COVID-19, there has been a delay within part two of the program and with a goal to have high school students who have successfully completed their respective courses begin their externship in Fall 2021. Activity 1.3 - Partnership with American Health Association - AHLM's successful collaboration with the Lodi Chamber of Commerce's Healthy Lodi initiative and the American Heart Association allows continued work to address economic security. Together we worked with local HR Directors, Workplace Wellness Champions and other organizational leaders to help their employees learn more about working towards cardiovascular health. The American Heart Association's Workplace Health Solutions is a "science-based, evidence-informed package of tools and services to help build and maximize an effective workplace culture of health". Building a healthy work environment and promoting a healthy workforce can lead to improved efficiency, reduced absenteeism, and cost savings for both workers and employers. In 2020, 12 companies were recruited to the Workplace Health Solutions, Seven companies submitted 2020 data, nine champions were trained, and a total of three webinars were offered. We are working to elevate a culture of health for the 4,100 employees covered under Workplace Health Solutions. Building a healthy work environment and promoting a healthy workforce can lead to improved efficiency, reduced absenteeism, and cost savings for both workers and employers. Priority Need 3 - Obesity/Healthy Eating Active Living (HEAL)/Diabetes - the goal is to increase physical activity for all ages and establish programs in high-risk neighborhoods. Strategy 1 - Engage businesses and community organizations to improve facilities and offer programs for physical activity. Activity 1.1 - Convene a Community Faith Summit in 2020 to encourage cross-sector collaboration and improve parks and neighborhoods. The Community Faith Summit which was originally planned for 2020 was placed on hold due to the COVID-19 pandemic and was pushed to a virtual event in March 2021. This event served to gather faith-based organizations, school and city leaders to encourage cross-sector collaboration to impact our neighborhoods. The goal is that through inspiration and financial support through mini grants, these entities would create projects/initiatives in parks and neighborhoods that would target obesity/diabetes, as well as mental health and economic security/education. Activity 1.2 - Diabetes Among Friends - These classes consist of a five-week diabetes self-management education (DSME) curriculum that is available in English and Spanish from Scripps Whittier Diabetes Institute. This program is approved as a (DSME) Program by the American Diabetes Association and covers all diabetes self-management topics including understanding blood sugars, nutrition, physical activity, medication management, stress management, foot care, ongoing screening tests and exams, etc. Number of persons served: 52. Additional activities such as Healthy Choices did not take place in 2020 due to the size of the class and technical challenges experienced by participants who joined the virtual classes. AHLM will be partnering with English Oaks Seventh-Day Adventist Church to hold classes starting in 2021. Likewise, all events where blood pressure and blood glucose screenings are normally performed were placed on hold and will resume in 2021. Part V, Section B, Line 11: Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health Lodi Memorial is committed to serving the community by adhering to its mission, and using its skills, expertise, and resources to provide a range of community benefit programs. 1. Violence/Injury Prevention: Need is being addressed by others. 2. Access to Care: Need is being addressed by others. 3. Substance Abuse/Tobacco: Need is currently being addressed by others, however, if we are awarded the Behavioral Health Pilot Project grant, we will be able to address this need through hiring a Substance Use Navigator. 4. Asthma: AHLM does not have the resources necessary at this time to address this need. 5. Oral Health: Need is being addressed by others. 6. Climate and Health: Our hospital does not have the expertise to effectively address this need. 17 1 - Lodi Outpatient Surgical Center 521 S Ham Lane Suite F Lodi CA 95242 Ambulatory Surgical Center 2 - AHLM Wound & Hyperbaric Care 2415 W Vine Street Suite 106 Lodi CA 95242 Outpatient Clinic - Hyperbaric & Wound Care 4 - AHLM Millsbridge Family Medicine 1901 W Kettleman Lane Suite 200 Lodi CA 95242 Community Clinic - Family Medicine 5 - Galt Family and Specialty Care 387 Civic Drive Galt CA 95632 Outpatient Clinic - Family Medicine 6 - Advanced Imaging Center at AHLM 1031 S Fairmont Avenue Lodi CA 95240 Outpatient Diagnostic Imaging 7 - AHLM Pediatric Care 2415 W Vine Street Suite 100 Lodi CA 95242 Outpatient Clinic - Pediatric care 8 - Urgent Care Clinic 1235 W Vine Street Suite 20 Lodi CA 95240 Outpatient Clinic - Urgent Care Services 9 - Ham Lane Clinic - Fairmont Ave 845 S Fairmont Avenue Suite 8 Lodi CA 95240 Outpatient Clinic - Cardiology & Pulmonology 10 - AHLM Family Medicine 2415 W Vine Street Suite 105 Lodi CA 95242 Outpatient Clinic - Family Medicine 11 - AHLM OrthopedicsSports Medicine 1235 W Vine Street Suite 22 Lodi CA 95240 Community Clinic - Orthopedics & Sports Medicine 12 - Adventist Health Home Health 800 S Lower Sacramento Road Lodi CA 95242 Home Care Services 13 - AHLM West Pharmacy 2415 W Vine Street Suite 104 B Lodi CA 95240 Retail Pharmacy 14 - AHLM Trinity Multi-Specialty Care 10200 Trinity Parkway Suite 102 Stockton CA 95219 Community Clinic - Multi-specialty Care 15 - Ione Family Care Clinic 305 Preston Avenue Ione CA 95640 Outpatient Clinic - Family Medicine 16 - AHLM Prenatal Care 2415 W Vine Street Suite 103 Lodi CA 95242 Outpatient Clinic - Prenatal Care 17 - AHLM Occupational Medicine 800 S Lower Sacramento Road Lodi CA 95242 Outpatient Clinic - Occupational Medicine 18 - AHLM Walter E Reiss Outreach Clinic 300 W Oak Street Lodi CA 95240 Free Clinic Part I, Line 7: Specific Ratios of Costs to charges are utilized for each department. Where applicable the source of these ratios are the Medicare Cost Report. Part II, Community Building Activities: The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities that we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020 Adventist Health completed the acquisition of Blue Zones as the first step toward reaching this goal. By partnering with Blue Zones, we are able to gain ground in shifting the balance from healthcare - treating people once they are ill - to transformative well-being - changing the way communities live, work and play. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H. Part III, Line 3: The Hospital provided care to all who presented themselves in our emergency room, without asking for proof of insurance. The Hospital's uninsured population continues to increase. Uninsured patients are screened for Medicaid linkage, given assistance in applying for Medicaid and if ineligible for Medicaid are given information regarding the Hospital's Charity Care Policy and encouraged to apply for charity care. Often the information gathered in the Medicaid application will make this determination "automatic". If additional information is required, the Hospital attempts to contact the patient. Those that do not respond will be sent to a collection agency after 120 days and four statements. The Hospital estimates 21% of bad debt expense (calculated at cost) should be considered charity care. The Hospital's bad debt accounts are analyzed by a third party to determine this amount. Part III, Line 4: Costing methodology:Utilizing the previous costing methodology as outlined in response to Part I, Line 7, all patients are assigned a payor class (i.e. charity, self pay, Medicare, Medi-Cal, managed care). The cost by payor is a summation of all patients in the assigned payor class. The amounts written off as bad debt (assigned to a collection agency) are net of any applicable payments or discounts. Any payments received after an account is assigned to a collection agency reduce the bad debt expense in the period received.Uncompensated care and community benefit costs:Our policy is to provide service to all who require it, regardless of their ability to pay. As such, the Hospital provides substantial amounts of uncompensated care. When this care is provided to patients who lack financial resources and therefore are deemed medically indigent, it is classified as charity care. When it is provided to patients who have the means to pay, but decline to do so, it is classified as provision for uncollectible accounts. Some undetermined portion of the provision for uncollectible accounts represents care to indigent patients who the Hospital has been unable to identity as charity. Charity care charges are not reflected in net patient service revenues. In addition, we provide services to poor and underserved persons who cannot afford health care because of inadequate resources and/or are uninsured or underinsured, including patients insured under certain government-reimbursed public aid programs. Such programs pay providers amounts that are less than established charges for the services provided to the recipients and frequently the payments are less than the costs of rendering the services.Patient accounts receivable:Patient accounts receivable for services provided to patients covered under the Medicare and Medicaid (Medi-cal in California) programs, privately sponsored managed care programs for which payment is made based on terms defined under formal contracts, and other payors (including self-pay) are recorded at their estimated realizable value based on contractual billing rates or our standard billing rates for our non-contracted payors. The Hospital regularly reviews accounts and contracts and provide appropriate estimates of contractual allowances that are then netted against patient accounts receivable. The Hospital also provides an estimated allowance for uncollectible accounts based on the Hospital's evaluation of the aging of our patient accounts receivable, the Hospital's historical collection experience for each type of payor and other relevant factors.The Hospital's primary concentration of credit risk is patient accounts receivable, which consists of amounts owed by various governmental agencies, insurance companies and private patients. The Hospital grants credit without collateral to the Hospital's patients and third party payors. Part III, Line 8: The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the united states. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care "market basket" is unrelated to that of the average individual consumer. Since the 1997 balanced budget act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others.Without Medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare revenue from the Hospital's Medicare Cost Report to GL: Revenue Rec. *Medicare Cost Report revenue 52,905,894 Prior year settlements 1,079,779 Cost report reimbursable bad debts 723,498 Non-Cost Report Revenue 18,495,146 Estimates and accrual variances 456,429 Other (1,752,776) Total Medicare revenue 71,907,970*Note: the Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts. Allowable costs are calculated from information in the Medicare Cost Report and paid claim summaries obtained from the Medicare program. Part III, Line 9b: When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is "low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest Part VI, Line 2: The Hospital's 2019 CHNA, the 2021 Community Health Plan (CHP) Update for fiscal year 2020, and the 2020 Implementation Strategy adopted in 2020 are posted on the hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/The two most recent Community Health Needs Assessments, two most recent Implementation Strategy reports and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs, with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, Lodi Memorial Hospital Association, Inc. supports local partners to augment our own efforts, and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of our region. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community. Part VI, Line 3: The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at:https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance. Part VI, Line 4: Adventist Health Lodi Memorial considers San Joaquin County its primary service area as well as the city of Galt. San Joaquin County contains both rural and urban areas. Communities and cities maintain their unique geographic identities, separated by agriculture and open space lands. The county includes seven incorporated cities: Stockton, Tracy, Manteca, Lodi, Lathrop, Ripon and Escalon as well as many small well-established rural communities in the unincorporated areas.The demographic profile of San Joaquin county indicates a total population of 745,424 with 17.8% living in poverty and 24.9% of children living in poverty. Unemployment is 11.7% and the uninsured population is 11.7% as well. Of the population, 41.6% identify as Hispanic/Latino, 31.8% identify as White, 16.7% identify as Asian, 8.2% identify as Black, 5.3% identify as multiple races and 2.0% identify as Native American/Alaska Native. Part VI, Line 5: Our Hospital's mission is, "Living God's love by inspiring health, wholeness and hope." Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the "triple aim." The "Triple Aim" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community. Part VI, Line 6: The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area can provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals. Part VI, Line 7, Reports Filed With States CA Part VI - Other Information In 2020, Adventist Health as a system took the following actions in response to the needs created or exacerbated by COVID-19: Adventist Health as a system directed "Community Strength Fund grants" to each hospital to support community partners' immediate response to COVID-19; Adventist Health as a system directed "Community Integration Catalyst" funds to each hospital to support internal new or expanded community well-being programming and innovation as an immediate response to COVID-19; began offering more virtual health care visits to keep community members safe and healthy; developed an online symptom tracker to help community members determine if they may have COVID-19 or some other flu type illness and what steps to take; partnered with MaskUp, a collaboration of 100 leading health systems representing thousands of hospitals across the U.S. joining to create messages for the betterment of the communities they serve.Locally, AHLM took additional actions: Adventist Health Lodi Memorial conducted four phases of COVID-19 testing outreach specifically to our Latino community members in both Lodi and Stockton. This was in response to the disproportionate incidences of COVID-19 rates amongst the Latino community. The first outreach event was held in a Lodi location considered a "hot spot" for COVID-19 cases. AHLM partnered with Rancho San Miguel on Friday, July 3rd, 2020 and administered 355 COVID tests outside of the grocery store in Lodi. The second outreach event was held within the parking lot of the First Baptist Church in Lodi and 105 people were tested. Free meals were provided, as well as education on disease prevention. The third testing event was held at a migrant farmworker's apartment site and approximately 80 individuals were tested. The fourth testing event was done in partnership with the City of Stockton. The City of Stockton awarded AHLM with a grant to conduct testing. Testing was held at the SJC Fairgrounds from September 18th through September 20th, 2020. Additionally, AHLM partnered with Dameron Hospital, as well as other hospitals and agencies such as Community Medical Centers, Dignity Health St. Joseph's Medical Center, Sutter Tracy Hospital, United Way, Catholic Charities, and many more. Together we sought to provide education to Latino farmworkers and their families on COVID-19 prevention and mitigation. COVID-19 testing was provided through Trident Care. During the three-day event, families were also given food boxes from donations made by the Salvation Army and the United Way. United Way also donated kits which included masks and hand sanitizers. Health Plan of San Joaquin hosted a booth to provide individuals with information about Medi-Cal enrollment. A total of 617 community members were tested at the SJC Fairgrounds. 1 CA Health Fund & Trust 1215 K Street Ste 800 Sacramento CA 95814 941498697 501(c)(3) 122093 Hlth srvs un/underinsured pt American Heart Association PO Box 50085 Prescott AZ 86304 135613797 501(c)(3) 50000 Walk for Good Heart United Way of San Joaquin County 777 N Pershing Avenue Suite B Stockton CA 95203 941279805 501(c)(3) 21500 Donation to HealthForce Partners 3 0 Part I, Line 2: Through the use of temporarily restricted accounts, we track and monitor the incoming receipts from grants and the utilization of grant funds. Each grant is tracked separately. Should the grantor agency require specific reports, we comply with their reporting requirements. The grants we monitor are specific to the grantor's needs and requests. X X X X 1 1 0 0 0 0 0 0 0 Larsen David - Former Finance Officer, CCR thru 04/19 0 595439 0 106067 0 2501054 0 576851 0 37800 0 3817211 0 2400418 Reiner Scott Dir/Chair 0 1631895 0 352059 0 374424 0 17042 0 37777 0 2413197 0 349200 Wing Bill Dir/Asst Secr/Vice Chair 0 1458328 0 279883 0 22116 0 17042 0 42012 0 1819381 0 0 Jahn Andrew President, Care Division 0 992796 0 210574 0 162471 0 17042 0 42265 0 1425148 0 0 Ferch Wayne President, CCR 0 1018284 0 250697 0 29626 0 17042 0 32144 0 1347793 0 0 Nahapetian Arby - Care Division Chief Medical Officer 0 648088 0 107260 0 112858 0 12449 0 42262 0 922917 0 0 Reppert Joseph Former CFO/Asst Secr thru 08/19 0 2779 0 0 0 810646 0 0 0 41111 0 854536 0 0 Jobe Meredith Secretary 0 575127 0 81637 0 113221 0 13010 0 30858 0 813853 0 0 Chen Steven Finance Officer, CCR 0 533654 0 104566 0 81492 0 17042 0 42132 0 778886 0 0 Wolcott Daniel President thru 12/20 0 510921 0 98950 0 86116 0 17042 0 42265 0 755294 0 0 Gruzensky Denton Reg HP Dir, CCR 0 121190 0 46929 0 439420 0 13766 0 22699 0 644004 0 0 Iris Patricia Medical Officer 0 374313 0 72568 0 45196 0 17042 0 27622 0 536741 0 0 Hofheins Todd CFO as of 08/20 0 297756 0 66 0 171285 0 0 0 13281 0 482388 0 0 Whitney Jason Treasurer 0 286032 0 46008 0 28027 0 17042 0 41990 0 419099 0 0 McCollough Brooke Operations Executive 0 274568 0 43988 0 21967 0 15550 0 46965 0 403038 0 0 Grimm Mary Patient Care Executive 0 300981 0 1906 0 29662 0 5700 0 37185 0 375434 0 0 Cook Becky - Ambulatory & Physician Services Exec 0 235561 0 14959 0 29254 0 12227 0 27151 0 319152 0 0 Moreno Debbe Former CNO thru 09/19 0 0 0 19902 0 258534 0 0 0 30401 0 308837 0 0 Markovich Jennifer Director, RN 182008 0 20500 0 30417 0 10762 0 44647 0 288334 0 0 0 Wagner Jack Former Asst Secr thru 03/18 0 0 0 0 0 269387 0 0 0 13558 0 282945 0 0 Beck Atwater Sandra Director Hospital Pharmacy 219873 0 9155 0 0 0 12970 0 33130 0 275128 0 0 0 Carmody Thomas Physician Assistant 230865 0 4540 0 0 0 13008 0 23097 0 271510 0 0 0 Karagounis Timothy Operations Executive 198387 0 29009 0 1434 0 11471 0 21493 0 261794 0 0 0 Pascua Helen RN, First Assistant 231388 0 1029 0 6055 0 9369 0 8115 0 255956 0 0 0 Pickering Christine Communication Dir, CCR 0 154923 0 22769 0 5071 0 9073 0 54065 0 245901 0 0 Part I, Lines 4a-b Severance payments are made based upon agreements between certain qualifying employees and Adventist Health Services/West. Details of the terms and conditions of the severance agreements are available to the IRS upon request. Gruzensky, Denton - severance payment - $419,587 Moreno, Debbe - severance payment - $257,371 Reppert, Joseph - severance payment - $809,806 Wagner, Jack - severance payment - $269,387 The Supplemental Executive Retirement Plan (SERP) is a defined contribution plan designed to encourage the participants continued employment with Adventist Health and is subject to the participants satisfying specified substantial risks of forfeiture. The SERP benefit distribution occurs when the executive achieves 30 years of Adventist health care service, 20 of which are to be as an executive and at least 10 are to be with Adventist Health System/West, and reaches age 60. Until that time, the SERP benefit is at risk to the creditors of Adventist Health. The SERP benefit is designed to help the executive receive employer-provided retirement benefit income equal to 60% of pre-retirement income. The SERP plan was frozen for new participants in 2016. Larsen, David - funding - $559,809 Larsen, David - vested distribution - $2,400,418 Select executives agreed to participate in CAP-EX in place of a traditional insurance SERP. See Schedule L, Part V of Adventist Health System/West, for a broader description. Split-Dollar life participants are Wayne Ferch, Scott Reiner, Jack Wagner, and Bill Wing. A flexible benefits plan (CAA) is offered to groups of highly-compensated employees meeting certain criteria. The participants are provided with an amount equivalent to 41 percent of their base compensation, less the value of their corporate provided benefits. The balance is set aside for non-vested deferred compensation that is subject to substantial risk of forfeiture and is at risk to the creditors of Adventist Health. Payouts occur according to the participants' payment elections after all substantial risks of forfeiture have lapsed. The plan was frozen for new non-vested contributions in 2016. Reiner, Scott - $349,200 P Gill Obstetrics and Gynecology >35% owned partnership by Parampal Gill, former board member 71665 Physician professional service-OB Clinic 0 P Gill Obstetrics and Gynecology >35% owned partnership by Parampal Gill, former board member 301950 Physician professional service-Emergency room call 0 X 1 543000 Net book value 0 0 1 0 Part I, Column (b): Column (b) reports the number of contributors. Form 990, Part III, Line 4a: Adventist Health Lodi Memorial (AHLM) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of AHLM, the organization recognizes that not all individuals possess the ability to pay for essential medical services. Adventist Health's vision is to enhance the health of the communities where we live and serve by engaging our communities and our patients in a new definition of and partnership for personal community health. In keeping with this commitment to serve all members of the community, the following will be considered when individuals who need health care cannot afford to pay: - providing free care and/or subsidized care - providing care to persons covered by governmental programs at below cost - providing health/wellness activities and community education programs Not only does AHLM provide low cost care to individuals covered by government-programs and those unable to afford healthcare, it also helps patients find and access private and governmental resources for healthcare benefits. AHLM recognizes below-cost reimbursement as charity and uncompensated care in meeting its mission to the entire community. The unreimbursed cost of providing care to these patients in 2020 was $14,803,322. The following Inpatient services were provided to all our patients. These services included: - 975 Babies delivered - 1,124 Surgeries performed - 27,152 Patient days The following Outpatient services were provided to all our patients. These services included: - 42,339 Emergency department visits - 2,977 Outpatient Surgeries performed - 57,178 Outpatient visits - 139,184 Clinic visits AHLM recognizes it has an obligation to provide human services above and beyond its role as a healing facility. The following community benefits demonstrate the tangible ways in which the organization is fulfilling its mission. The total unreimbursed cost of these community benefits in 2020 was $16,159,185. Adventist Health's mission statement of Living God's love by inspiring health, wholeness and hope is coupled with a vision to transform the health experience of our communities through collaborative programs, community investments and community outreach. We are inspired by the healing ministry as represented by the life of Jesus Christ and believe we are called to live out our mission intentionally in the communities we serve. In the small towns, suburbs and inner cities we serve, we continue our journey to provide quality healthcare until every person made in God's image has experienced the best health today, hope for tomorrow, and God's love that endures forever. Websites for our community benefit information: https://www.adventisthealth.org/about-us/community-benefit/ Form 990, Part VI, Section A, line 6 The Hospital is organized as a religious corporation and operates as a not-for-profit hospital. The sole corporate member is Adventist Health System/West, a California not-for-profit religious corporation. The Hospital operates as an affiliate of Adventist Health System/West. Form 990, Part VI, Section A, line 7a The Hospital Bylaws define its Board of Directors to be the same individuals who are members of the Adventist Health System/West Board of Directors. Form 990, Part VI, Section A, line 7b The sole corporate member, Adventist Health System/West, must approve all changes to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11b This Form 990 including all supporting schedules was prepared by a public accounting firm, reviewed by the System Controller and Market Finance Officer, and shared by electronic communication with the Hospital's Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c During the first quarter of each year, the annual conflict of interest questionnaire is sent to board members, hospital officers, key employees and department directors for completion and signature. The questionnaire is accompanied by a letter of explanation to illustrate examples of a conflict and to remind the recipient that if any perceived conflict should arise before the next annual questionnaire, he/she is to notify the market president immediately. The System General Counsel distributes, collects, and reviews for signatures the COIs for all applicable Corporate employees, stakeholders and the board. In addition, the hospital's administration is responsible for keeping record to ensure all hospital-based individuals with director and above positions have submitted their COIs. The System General Counsel reviews all the disclosures on the board and Corporate employees' COIs. System General Counsel retains the COIs for all individuals. Copies for the officers and key employees' COIs are kept in their personnel files. Further inquiries on any potential significant conflicts are made as needed. Conflicts are documented and reviewed with the Board. Form 990, Part VI, Section B, line 15 The Hospital's Board of Directors has established a Compensation Committee to oversee the executive compensation program. This committee is composed of independent directors with no conflicts of interest. The committee performs the following functions: recommends a total compensation philosophy to the board; assures compliance with the board-approved philosophy; meets annually to review comparability data from outside consultants; recommends any adjustments to current executive compensation, including salary ranges for hospital Presidents and Finance Officers, that would be indicated by the data; evaluates executive performance against annual goals; recommends appropriate incentive awards to the board for approval; follows a diligent process that meets regulatory requirements for a rebuttable presumption of reasonableness; records committee deliberations and decisions in timely minutes; selects, engages and supervises any consultant hired to advise and provide comparability data. The board-approved executive compensation philosophy specifies that salary ranges will be established for hospital Presidents and executives, with midpoints aligned with the 50th percentile of comparable system hospital data, and having a 50 percent spread from minimum to maximum. A hospital President has a maximum potential incentive of 30 or 35 percent of base salary based upon size and scope of hospital (incentive potential is industry norm). Other hospital executives have a maximum potential incentive of 25 to 30 percent of base salary. Form 990, Part VI, Section C, line 19 The Hospital does not make its governing documents publicly available, beyond required filings of Articles of Incorporation with the Secretary of State. The Hospital does not make its Conflict of Interest Policy available upon request, but does file monthly/quarterly summary financial reports with the state health-planning agency. Form 990, Part VII: In recognition of the time commitment directors make to serve on the Adventist Health System/West boards and committees, directors have the option to receive compensation when their employment agreements with their employers allow such payments. In addition, amounts paid for taxable benefits are also reported. Form 990, Part IX, line 11g Physician fees: Program service expenses 23,630,198. Management and general expenses 829,985. Fundraising expenses 0. Total expenses 24,460,183. Other medical professional fees: Program service expenses 40,989. Management and general expenses 9,419. Fundraising expenses 0. Total expenses 50,408. Consulting fees: Program service expenses 396,664. Management and general expenses 214,878. Fundraising expenses 0. Total expenses 611,542. Contract labor: Program service expenses 3,501,354. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,501,354. Repairs and maintenance: Program service expenses 426,277. Management and general expenses 2,165. Fundraising expenses 0. Total expenses 428,442. Cerner management fees: Program service expenses 0. Management and general expenses 8,162,909. Fundraising expenses 0. Total expenses 8,162,909. All other purchased services: Program service expenses 7,268,949. Management and general expenses 1,954,209. Fundraising expenses 8,657. Total expenses 9,231,815. Purchased medical services: Program service expenses 3,622,873. Management and general expenses 140,351. Fundraising expenses 0. Total expenses 3,763,224. Other professional fees non-medical: Program service expenses 0. Management and general expenses 13,315. Fundraising expenses 0. Total expenses 13,315. Form 990, Part XI, line 9: Change in investments of subsidiaries -1,495,201. Artel LLC (dba Lodi Outpatient Surgery Center) 521 S Ham Lane Suite F Lodi CA 95240 263513966 Ambulatory surgical centers CA 2324955 1265570 Lodi Memorial Hospital Association Inc Adventist Health Clearlake Hospital Inc 15630 18th Avenue Clearlake CA 95422 680395149 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Delano 1401 Garces Highway Delano CA 93215 770258013 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Medical Center Tehachapi 1100 Magellan Drive Tehachapi CA 93561 812240617 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Adventist Health Mendocino Coast 700 River Drive Fort Bragg CA 95437 845174585 Hospital CA 501(c)(3) Line 3 Stone Point Health 0 Adventist Health Physicians Network PO Box 619135 Roseville CA 95661 680357690 Medical foundation CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Adventist Health SystemWest PO Box 619135 Roseville CA 95661 953484589 Integrated health system CA 501(c)(3) Line 10 N/A 0 Adventist Health Tulare 869 North Cherry Street Tulare CA 93274 832351753 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Castle Medical Center 640 Ulukahiki Street Kailua HI 96734 990107330 Hospital HI 501(c)(3) Line 3 Adventist Health SystemWest 0 Feather River Hospital PO Box 619135 Roseville CA 95661 941101228 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Fremont-Rideout Health Group 989 Plumas Street Yuba City CA 95991 942917251 Acute care hospital CA 501(c)(3) Line 12b, II Stone Point Health 0 Glendale Adventist Medical Center 1509 Wilson Terrace Glendale CA 91206 951816017 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Hanford Community Hospital 115 Mall Drive Hanford CA 93230 940535360 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Northwest Medical Foundation of Tillamook 1000 Third Street Tillamook OR 97141 930622075 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Paradise Valley Hospital PO Box 619135 Roseville CA 95661 951816034 Discontinued Operations CA 501(c)(3) Line 1 Adventist Health SystemWest 0 Portland Adventist Medical Center 10123 SE Market Street Portland OR 97216 930429015 Hospital OR 501(c)(3) Line 3 Adventist Health SystemWest 0 Reedley Community Hospital 372 Cypress Avenue Reedley CA 93654 453220509 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Rideout Memorial Hospital 989 Plumas Street Yuba City CA 95991 941387866 Acute care hospital CA 501(c)(3) Line 3 Stone Point Health 0 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 952294234 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Simi Valley Hospital and Health Care Services 2975 N Sycamore Drive Simi Valley CA 93065 956064971 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Sonora Community Hospital 1000 Greenley Road Sonora CA 95370 941415069 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 St Helena Hospital 10 Woodland Road St Helena CA 94574 941279779 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Stone Point Health PO Box 619135 Roseville CA 95661 823763347 Supporting organization CA 501(c)(3) Line 12b, II Adventist Health SystemWest 0 Ukiah Adventist Hospital 275 Hospital Drive Ukiah CA 95482 941639901 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 United Com-Serve 989 Plumas Street Yuba City CA 95991 943015356 Skilled nursing/assisted living/home health CA 501(c)(3) Line 12b, II Stone Point Health 0 Walla Walla General Hospital PO Box 619135 Roseville CA 95661 910617726 Hospital - closed July 2017 WA 501(c)(3) Line 3 Adventist Health SystemWest 0 Western Health Resources PO Box 619135 Roseville CA 95661 953867863 Home care CA 501(c)(3) Line 10 Adventist Health SystemWest 0 White Memorial Medical Center 1720 Cesar E Chavez Avenue Los Angeles CA 90033 952282647 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Willits Hospital Inc 1 Marcela Drive Willits CA 95490 680108919 Hospital CA 501(c)(3) Line 3 Adventist Health SystemWest 0 Advanced Imaging Center at Lodi Memorial Hospital LLC (AIC) 1001 S Fairmont Avenue Lodi CA 95240 943407786 Diagnostic imaging / MRI outpatient treatment center CA Lodi Memorial Hospital Association Inc Related -333234 4165623 0 0 1.00000 Artel LLC (dba Lodi Outpatient Surgery Center) 521 S Ham Lane Suite F Lodi CA 95240 263513966 Ambulatory surgical centers CA Lodi Memorial Hospital Association Inc Related 47197 732391 0 0 1.00000 Endoscopy Center of Lodi LLC 975 S Fairmont Avenue Lodi CA 95240 261243662 Endoscopy services CA Artel LLC Related 0 0 1.00000 Blue Zones LLC 323 N Washington Avenue 2nd Floor Minneapolis MN 55401 271603327 Education MN N/A 0 0 PVHR LLC dba Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 260622555 Real property rental OR N/A 0 0 PVHR2 LLC dba Parkview at Paradise Village 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 473300170 Real property rental OR N/A 0 0 WWGHR LLC 8440 SE Sunnybrook Blvd Suite 100 Clackmas OR 97015 810591221 Rental OR N/A 0 0 Delta Radiology Inc 975 S Fairmont Avenue Lodi CA 95240 941715690 Radiology services CA Lodi Regional Health Systems Inc C 3238361 1257989 1.00000 0 Lodi Regional Health Systems Inc 975 S Fairmont Avenue Lodi CA 95240 680398894 Physician management and medical office building development & management CA Lodi Memorial Hospital Association Inc C 4323044 12691389 1.00000 0 AdHealth Limited PO Box HM 2062 Hamilton BD HM HX Pure captive insurance BD N/A C 0 Adventist Health Plan Inc 1 Adventist Health Way Roseville CA 95661 463833261 Health insurance CA N/A C 0 South Coast Medical Center PO Box 619135 Roseville CA 95661 952037297 Wind down after sale of hospital CA N/A C 0 Thrive Productions Inc 323 N Washington Avenue Minneapolis CA 55401 453369049 Production company MN N/A C 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 Lodi Regional Health Systems Inc K 94451 Lodi Regional Health Systems Inc O 213719 Advanced Imaging Center at Lodi O 703896 Artel LLC O 1123773 Delta Radiology Inc P 620376